Scrotal swellings are a common presenting complaint in the outpatient clinic. It is also important to distinguish between those swellings that have underlying serious pathology (testicular tumour) and those that are simple and benign (epididymal cysts).

Causes

  • Sebaceous cyst

  • Indirect inguinal hernia

  • Hydrocele

  • Epididymal cyst (spermatocele) ( Fig. 54 )

    Figure 54, Epididymal cyst .

  • Epididymo-orchitis

  • Testicular torsion

  • Testicular tumour

  • Varicocele

  • Haematocele

  • Sperm granuloma

  • TB • (common where TB is endemic)

  • Gumma

History

Please also refer to the chapter on scrotal pain.

Sebaceous cyst

The patient may complain of several painful lumps on the scrotal skin. There may be a history of one or more of them becoming red, inflamed and tender with discharge.

Indirect inguinal hernia

The patient will be often aware of a lump in their groin. They may be able to reduce it. The hernia may present with a painful, irreducible swelling and signs of intestinal obstruction.

Hydrocele

An idiopathic hydrocele usually presents as a painless scrotal swelling, which may become quite large. They usually occur over the age of 50 years. Occasionally, there may be pain and discomfort if there is underlying testicular disease. A younger patient presenting with a hydrocele should raise the suspicion of an underlying malignancy.

Epididymal cyst

This presents as a painless scrotal swelling. Epididymal cysts may slowly enlarge over many years. They may be bilateral.

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